The Resource Adjunctive devices for patients with acute coronary syndrome undergoing percutaneous coronary intervention, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by University of Connecticut/Hartford Hospital Evidence-based Practice Center ; investigators, Diana M. Sobieraj ... [et al.], (electronic resource)

Adjunctive devices for patients with acute coronary syndrome undergoing percutaneous coronary intervention, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by University of Connecticut/Hartford Hospital Evidence-based Practice Center ; investigators, Diana M. Sobieraj ... [et al.], (electronic resource)

Label
Adjunctive devices for patients with acute coronary syndrome undergoing percutaneous coronary intervention
Title
Adjunctive devices for patients with acute coronary syndrome undergoing percutaneous coronary intervention
Statement of responsibility
prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by University of Connecticut/Hartford Hospital Evidence-based Practice Center ; investigators, Diana M. Sobieraj ... [et al.]
Contributor
Subject
Language
eng
Summary
OBJECTIVES: This is a Comparative Effectiveness Review examining the benefits to harms of adjunctive devices to remove thrombi or protect against embolization in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) of native vessels. DATA SOURCES: MEDLINE(r), Cochrane Database, and abstracts from major cardiology meetings were searched from 1996 through March 2011, as were www.clinicaltrials.gov and references from identified citations. REVIEW METHODS: Randomized controlled trials (RCTs), controlled observational studies enrolling 500 patients, and systematic reviews were eligible for inclusion. Data amenable to meta-analysis were pooled as relative risks (RRs) with accompanying 95-percent confidence intervals using a random-effects model. RESULTS: A total of 175 articles were included. Three direct comparative RCTs were identified comparing catheter aspiration with distal balloon protection devices or other catheter aspiration devices; they showed no significant differences for evaluated outcomes. The data comparing adjunctive devices with standard PCI (control) are predominantly in patients with ST-segment elevation myocardial infarction (STEMI). In RCTs conducted in STEMI patients, catheter aspiration devices decreased the risk of a major adverse cardiovascular event (MACE) [RR 0.73 (0.61-0.88)] versus control. Catheter aspiration devices increased the achievement of ST-segment resolution [RR 1.51 (1.32-1.73)], myocardial blush grade of 3 (MBG-3) [RR 1.61 (1.41-1.84)], and thrombolysis in myocardial infarction (TIMI) 3 flow [RR 1.08 (1.04-1.12)], while reducing distal embolization [RR 0.56 (0.39-0.79)], no reflow [RR 0.52 (0.35-0.76)], and coronary dissection [RR 0.30 (0.12-0.75)] versus control. Other final health and intermediate outcomes were not significantly impacted by catheter aspiration devices versus control. In a majority of trials, the use of catheter aspiration devices increased procedural time upon qualitative assessment. Distal filter embolic protection devices increased the risk of target revascularization [RR 1.61 (1.03-2.54)], although the use of mechanical thrombectomy or embolic protection devices did not significantly impact other final health outcomes or harms in RCTs. Qualitative assessment indicated that procedure time was increased versus control. Distal balloon or any embolic protection device increased the achievement of MBG-3 [RR 1.39 (1.15-1.69) and RR 1.20 (1.02-1.40), respectively] and TIMI-3 flow [RR 1.11 (1.03-1.19) and RR 1.06 (1.01-1.12), respectively] but did not significantly impact other intermediate outcomes versus control. Mechanical thrombectomy, distal filter, or proximal balloon embolic protection devices did not significantly impact any of the intermediate outcomes evaluated versus control. The associations between predetermined factors and outcomes in people receiving adjunctive devices were generally insufficient. CONCLUSIONS: For most devices, there are few RCTs evaluating final health outcomes over a long period of followup, and furthermore the data outside of STEMI are scarce. Due to insufficient data, the safety of these devices is unclear
Member of
Cataloging source
DNLM
NLM call number
WG 300
http://library.link/vocab/relatedWorkOrContributorName
  • Sobieraj, Diana M
  • United States
  • University of Connecticut-Hartford Hospital Evidence-based Practice Center
  • Effective Health Care Program (U.S.)
Series statement
  • Comparative effectiveness review
  • AHRQ publication
Series volume
  • no. 42
  • no. 11(12)-EHC089-EF
http://library.link/vocab/subjectName
  • Acute Coronary Syndrome
  • Catheterization
Label
Adjunctive devices for patients with acute coronary syndrome undergoing percutaneous coronary intervention, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by University of Connecticut/Hartford Hospital Evidence-based Practice Center ; investigators, Diana M. Sobieraj ... [et al.], (electronic resource)
Instantiates
Publication
Note
  • "Contract no. 290-2007-10067-I."
  • "December 2011."
Bibliography note
Includes bibliographical references
Control code
OCM1bookssj0000973758
Dimensions
unknown
Specific material designation
remote
System control number
(WaSeSS)bookssj0000973758
Label
Adjunctive devices for patients with acute coronary syndrome undergoing percutaneous coronary intervention, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by University of Connecticut/Hartford Hospital Evidence-based Practice Center ; investigators, Diana M. Sobieraj ... [et al.], (electronic resource)
Publication
Note
  • "Contract no. 290-2007-10067-I."
  • "December 2011."
Bibliography note
Includes bibliographical references
Control code
OCM1bookssj0000973758
Dimensions
unknown
Specific material designation
remote
System control number
(WaSeSS)bookssj0000973758

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